The effect of massive transfusion protocol implementation on the survival of trauma patients: a systematic review and meta-analysis
Fecha
2020-03-15Autor
Consunji, Rafael
Elseed, Alaa
El-Menyar, Ayman
Sathian, Brijesh
Rizoli, Sandro
Al-Thani, Hassan
Peralta, Ruben
Metadatos
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Massive transfusion protocol (MTP) has been widely adopted for the
care of bleeding trauma patients but its actual effectiveness is unclear. An earlier
meta-analysis on the implementation of MTP for injured patients from 1990 to 2013
reported that only 2 out of 8 studies showed statistical improvement in survival.
This study aimed to conduct an updated systematic review and meta-analysis to
evaluate the effect of implementing an MTP on the mortality of trauma patients.
Materials and methods - MEDLINE, PubMed, Cochrane Library and Google
scholar databases were systematically searched for relevant studies published
from 1st January 2008 to 30th September 2019 using a combination of keywords
and additional manual searching of reference lists. Inclusion criteria were: original
study in English, study population including trauma patients, and comparison
of mortality outcomes before and after institutional implementation of an
MTP. Primary outcomes were 24-hour, 30-day, and overall mortality.
Results - Fourteen studies met inclusion criteria, analysing outcomes from 3,201
trauma patients. There was a wide range of outcomes, patient populations, and
process indicators utilised by the different authors. MTP significantly reduced the
overall mortality for trauma patients (OR 0.71 [0.56-0.90]). No significant reduction
was seen in either the 24-hour mortality (OR 0.81 [0.57-1.14]) or the 30-day mortality
(OR 0.73 [0.46-1.16]). However, when mortality timing was unspecified, mortality
was statistically reduced (OR 0.69 [0.55-0.86]).
Discussion - The present study found a significant reduction in mortality following
MTP implementation and thus it should be recommended to all institutions
managing acutely injured patients. To better identify which elements of an
MTP contribute to this effect, we encourage the use of standard nomenclature,
indicators, protocols and patient populations in all future MTP studies.
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